Problem: Diabetes is exacting an ever increasing health and financial toll on adult Americans. Since the majority of adults with DM seek care from primary care physicians, strategies to improve care in primary care practices present great opportunities for improving outcomes. The Chronic Care Model posits that successful management of a complex illness is dependent on productive interactions between informed, activated patients and prepared, pro-active, practice teams. One efficacious strategy to foster this desired interaction is self- management support, particularly using Motivational Interviewing and related behavior change strategies to help patients organize themselves around improving self-care. However, an implementation framework is needed that addresses the competing demands of primary care practice. Research Question: We will address the question: How can limited practice resources be reorganized to increase capacity to adopt and sustain self-management support for diabetes patients? Purpose: To evaluate the feasibility in three diverse primary care practices of a combined intervention utilizing an innovative practice level organizational implementation strategy-knowledge management;with a proven patient-focused strategies to provide self-management support in order to improve cardiovascular risk factors. Methods: A brief multimethod organizational assessment generates a profile of features focused on KM effectiveness and practice implementation of self-management support for diabetes patients. Equipped with this understanding, the practice works with a trained facilitator/consultant to realign current resources and training in Motivational Interviewing to enhance self-management support. A shared patient care plan in the medical record facilitates patients and practice members knowledge exchange to create and sustain interaction between better informed, activated patients and prepared, proactive practice team. Diabetes care outcomes and incremental net costs of the intervention will be assessed at baseline and 1 year. A multimethod process evaluation will occur throughout the pilot. Outcomes: Analysis of the feasibility study data will inform the development of a group randomized controlled trial of the intervention. Benefit: Findings from this study will be used to develop cost-effective methods for improving diabetes care in primary care practices.
(Public Health relevance Statement) Diabetes is the fifth leading cause of death in the US and the costs of diabetes care are estimated at $132 billion annually. Although most adults with diabetes seek their care from primary care physicians, adherence to diabetes treatment guidelines in these settings remains less than optimal. We propose to test in three primary care practices, the feasibility of a cost-effective innovative intervention designed to lead to improvement in cardiovascular risk factors through self-management support.
